高龄老年男性2型糖尿病合并冠状动脉粥样硬化性心脏病患者的临床特征及危险因素  

Clinical characteristics and risk factors of elderly male patients with type 2 diabetes mellitus complicated with coronary atherosclerotic heart disease

作　　者：张萌萌 郝良适 宁冰冰 陈志勇 段俊丽[1] Zhang Mengmeng;Hao Liangshi;Ning Bingbing;Chen Zhiyong;Duan Junli(Department of Geriatric,Xin Hua Hospital Affilliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;The Second Clinical Medical College of Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]上海交通大学医学院附属新华医院老年医学科,200092 [2]温州医科大学第二临床医学院,325035

出　　处：《中国综合临床》2021年第4期349-355,共7页Clinical Medicine of China

摘　　要：目的探讨高龄老年2型糖尿病(type 2 diabetes,T2DM)合并冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CHD)患者临床特征并分析T2DM患者发生CHD并发症的危险因素。方法采用回顾性队列研究方法,选取2017年1月至2020年1月上海交通大学医学院附属新华医院收治的406例高龄(≥75周岁)老年男性T2DM患者,分为T2DM未合并CHD组(165例)与T2DM合并CHD组(241例),分析高龄老年T2DM合并CHD患者临床特征及发生CHD的危险因素。结果T2DM合并CHD组患者年龄[(86.78±5.35)岁]、病程[(12.32±0.46)年]、空腹血糖(fasting plasma glucose,FPG)[(7.64±2.81)mmol/L]、糖化血红蛋白(hemoglobin a1c,HbA1c)[(7.59±1.21)%]、高血压占比[84.65%(204/241)]、D-二聚体[(0.50±0.13)mg/L]、血栓栓塞事件发生率[46.06%(111/241)]、血肌酐[(94.81±12.70)μmol/L]、尿素氮[(8.31±4.46)mmol/L]、尿酸[(376.44±116.01)μmol/L]均高于T2DM未合并CHD组[(78.51±4.81)岁、(10.66±0.67)年、(6.84±2.19)mmol/L、(7.02±2.15)%、63.03%(104/165)、(0.21±0.04)mg/L、13.33%(22/165)、(83.01±14.40)μmol/L、(6.79±2.89)mmol/L、(333.56±95.15)μmol/L],差异有统计学意义(t=15.908、t=2.042、t=3.055、t=3.088、χ^(2)=23.828、t=5.059、χ^(2)=42.098、t=2.401、t=4.188、t=4.075,P均<0.05);T2DM合并CHD组患者总胆红素[(8.80(6.60,11.60)μmol/L]、肾小球滤过率[glomerular filtration rate,GFR][(76.49±29.80)mL/(min·1.75 m^(2))]均低于T2DM未合并CHD组[11.25(8.23,15.28)μmol/L、(91.81±28.31)mL/(min·75 m^(2))],差异有统计学意义(Z=2.304、t=5.126,P均<0.001);T2DM合并CHD组患者总胆固醇[(3.84±0.85)mmol/L]、低密度脂蛋白胆固醇[low-density lipoprotein cholesterol,LDL-C][(2.12±0.68)mmol/L]低于T2DM未合并CHD组[(4.10±1.00)mmol/L、(2.45±0.85)mmol/L],差异有统计学意义(t=2.828、4.156,P均<0.05);T2DM合并CHD组患者启动降脂稳定斑块治疗率[82.57%(199/261)]高于T2DM未合并CHD组[42.42%(70/165)],差异有统计学意义(χ^(2)=70.614,P<0.001);受降Objective To explore the clinical characteristics of elderly patients with type 2 diabetes mellitus(T2DM)complicated with coronary atherosclerotic heart disease(CHD)and analyze the risk factors of CHD in patients with T2DM.Methods Using the method of retrospective cohort study,406 elderly male patients with T2DM(≥75 years old)admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University from January 2017 to January 2020 were selected and divided into T2DM without CHD group(165 cases)and T2DM with CHD group(241 cases).The clinical characteristics in elderly patients with T2DM complicated with CHD and risk factors for CHD were analyzed.Results The age((86.78±5.35)years old),course of T2DM((12.32±0.46)years),fasting blood glucose(FPG)((7.64±2.81)mmol/L),hemoglobin a1c(HbA1c)((7.59±1.21)%),the proportion of hypertension(84.65%(204/241)),D-dimer((0.50±0.13)mg/L),the incidence of thromboembolic events(46.06%(111/241)),blood serum creatinine((94.81±12.70)μmol/L),urea nitrogen((8.31±4.46)mmol/L),uric acid((376.44±116.01)μmol/L)in T2DM with CHD group were higher than those in T2DM without CHD((78.51±4.81)years old,(10.66±0.67)years,(6.84±2.19)mmol/L,(7.02±2.15)%,63.03%(104/165),(0.21±0.04)mg/L,13.33%(22/165),(83.01±14.40)μmol/L,(6.79±2.89)mmol/L,(333.56±95.15)μmol/L),and the differences were statistically significant(t=15.908,t=2.042,t=3.055,t=3.088,χ^(2)=23.828,t=5.059,χ^(2)=42.098,t=2.401,t=4.188,t=4.075;all P<0.05).The total bilirubin(TBil)(8.80(6.60,11.60)μmol/L),glomerular filtration rate(GFR)((76.49±29.80)mL/(min·1.75 m^(2)))in T2DM with CHD group were lower than those in T2DM without CHD group(11.25(8.23,15.28)μmol/L,(91.81±28.31)mL/(min·1.75 m^(2))),the differences were statistically significant(Z=2.304,t=5.126;all P<0.001).The total cholesterol((3.84±0.85)mmol/L),low-density lipoprotein cholesterol(LDL-C)((2.12±0.68)mmol/L)in T2DM with CHD group were lower than those in T2DM without CHD group((4.10±1.00)mmol/L,(2.45±0.85)mmol/L),the differences were statistically signifi

关 键 词：2型糖尿病 冠状动脉粥样硬化性心脏病 高龄男性 肾功能 血栓栓塞事件 

分 类 号：R587.1[医药卫生—内分泌] R541.4[医药卫生—内科学]